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Executive Summary

All managers know that they need to help their employees through challenging times. But almost no manager is prepared for when one of their direct reports announces that he or she has cancer, despite the fact that more than1.6 million peoplewill be diagnosed this year.If one of your employees tells you about a diagnosis,start by allowing themto control the terms of disclosure. They may want you to spread their news, or not. Then, help guide your team’s response so that the support they offer is actually what your sick employee needs. Next, develop a plan so that work can continue– and make sure you also develop a Plan B, in case the recovery process is longer than anticipated. Finally, don’t let tough decisions stall out while youremployee is away. It can be difficult, but you need to keep the business moving forward.

All managers know that they need to help their employees through challenging times – whether it’s a tough work situation like a tight deadline or high-stakes client, or a demanding personal situation, like a new baby or a sick parent. But almost no manager is prepared for when one of their direct reports announces that he or she has cancer, despite the fact that more than
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will be diagnosed this year.

As an executive coach who works with top corporate leaders, I’ve closely researched how managers can respond well or poorly when faced with such a situation. It’s also a lesson I learned firsthand when I was diagnosed with breast cancer in 2011. If one of your employees tells you about a diagnosis, here are four things to keep in mind.

Figure2

Event Rate for the Combined Outcome of Cardiovascular Hospitalization or Death by Quartile of UACR

Q= quartile; UACR= urinary albumin-to-creatinine ratio.

Figure3

Kaplan-Meier Survival Curve for the CompositeOutcome of CV Hospitalization or Death, Stratified by Median UACR

In a well-characterized HFpEF cohort, we evaluated the relationship between albuminuria, as measured by UACR, and clinical characteristics, echocardiographic parameters, and outcomes. Higher UACR was associated with higher rates of DM and CKD, and UACR was also associated with higher creatinine, higher blood urea nitrogen, and lower hemoglobin. We also found that higher levels of UACR were associated with markers of biventricular dysfunction and remodeling, even after adjustment for potential confounders, including DM and CKD. These cardiac markers included PRSW, log BNP, RV wall thickness, and RVFAC. Furthermore, UACR was associated with the composite outcome (cardiovascular hospitalization, HF hospitalization, or death) even after adjustment for age, sex, DM, CKD, CAD, and multiple markers of HF severity (except for BNP). Our study increases understanding of the echocardiographic correlates of albuminuria in HFpEF, particularly parameters of RV remodeling and dysfunction.

Prior study of albuminuria in HFpEF has been limited. Forty-two percent (n= 967) of the subjects from the CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) Programme had LV EF >40%
(6)
. The CHARM investigators described a prevalence of 30% and 11%for microalbuminuria and macroalbuminuria, respectively, in the combined HFpEF and HFrEF cohorts and showed that continuous UACR was similarly predictive of outcomes in HFpEF and HFrEF. Work from Miura etal. demonstrated the prognostic importance of positive urine dipstick test for urine albumin (a dichotomous indicator of albuminuria) in HFpEF but did not evaluate albuminuria as a continuous marker
(9)
. Recently, albuminuria was reported to predict incident HFpEF rather than HFrEF
(10)
. Like these previous studies, our work confirms the prognostic importance of UACR in HFpEF; however, as shown by our AUC and IDI analyses, the incremental benefit for UACR beyond traditional risk factors is limited. Aside from our results on UACR as a prognostic variable, we also found that the prevalence of microalbuminuria and macroalbuminuria in our cohort was similar to that recorded in CHARM patients with HFpEF, and associations of greater albuminuria with DM and CKD were similarly present in our study. In the Strong Heart Study, UACR was linked to systolic and diastolic dysfunction in type 2 DM
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; however, that study did not use tissue Doppler imaging and rather relied on E/A ratio and mitral deceleration time to measure diastolic function.